Introduction: Tracheostomy is commonly performed in patients requiring long-term ventilator support. There are many types of tracheostomy tubes like fenestrated and non-fenestrated tubes. This study is to compare the types of fenestrated tubes. Type I is a fenestrated tube with multiple small fenestrae and type II is a fenestrated tracheostomy tube with a single large fenestra. Materials and methods: A total of 87 patients who underwent tracheostomy due to prolonged ventilation from January 2015 to January 2016 were included in the study. Type I tube was used in 40 patients and type II tube was used in 47 patients. Tube change was done on the 10th day, at the end of 1 month, and at the end of 3 months. Flexible laryngoscopy is done during every tube change to assess the airway. Results: Two groups were compared in terms of granulation through fenestra, stomal granulation, frequency of suctioning, and inner tube block. Statistical analysis was done and the values were compared. A p value <0.05 was considered to be statistically significant. There was a statistically significant difference between both groups in terms of less incidence of granulation through the fenestra and stomal granulation in type II tube. Conclusion: Type II tubes are more patient compliant. The incidence of inner tube block is comparatively less which makes it safe to use and avoid life-threatening situations. Decannulation can be done earlier and without complications in patients with type II tubes due to the less incidence of stomal granulation. Thus, type II tube is safer to use and has minimal complications.